Although age-adjusted prevalence of diagnosed diabetes is 16.3% in American Indians, 20 years or older living in the Northern Plains Region, age-adjusted prevalence of diabetes is only 0.23% in Montana Indian youth, age 20 years or less. These data suggest that diabetes prevention programs for American Indian youth may hold the most promise for decreasing diabetes risk in future generations of American Indian adults. The Diabetes Prevention Program (DPP) showed efficacy when conducted with adults in resource intensive settings. Therefore, implementing unmodified DPP intervention activities with American Indian children and adolescents is likely to be ineffective and inappropriate for this age and cultural group. Using a community based participatory research (CBPR) approach, this project will translate and test the evidence based DPP curriculum modules for American Indian youth, age 10-14. The formative phase of the project includes DPP material adaptations by project investigators and curriculum experts, Northern Plains Indian community focus group discussions (n=40 participants) that further refine the adapted materials, and final material revisions by project experts. The formative phase prepares for a pilot study of the adapted-DPP curriculum. The quantitative phase of the project will be a 32-week pilot study that determines intervention fidelity and magnitude of pre- to posttest changes on dietary intake, physical activity, body mass index (BMI), blood pressure, skinfold thickness, waist circumference, acanthosis, fasting plasma glucose, LDL-C, HDL-C, TC and triglycerides in 64 American Indian youth, age 10-14 years, receiving the treatment (adapted-DPP modules) or control curriculum. This R34 project will develop preliminary data that will demonstrate the feasibility of conducting a longer term randomized trial of the intervention (future R18 trial) to test the adapted DPP for preventing risk for type-2 diabetes in American Indian youth. If proven effective, these studies will provide potentially valuable and translatable diabetes prevention strategies for American Indian youth across the nation. 7. Project Narrative This project could provide an effective and translatable diabetes prevention program for American Indian youth across the nation. If the strategies are proven effective in the subsequent, full-scale trial of the intervention, the methods could prevent high rates of death from diabetes by reducing risk factors associated with diabetes risk at an early age. These long-term health effects will save dollars by reducing diabetes, cardiovascular and obesity-related health care costs and will reduce health disparities in Native American populations. [unreadable] [unreadable]